About Verse Medical

We’re building the software infrastructure that enables hospital-quality care, at home. As healthcare costs have increased, the patient’s home has become incredibly important as a site of care.

Yet, patients recovering at home are highly underserved. Patients can only get better at home if they receive the high-quality care that they need reliably. The existing in-home care process involves a patchwork of different vendors, all connected through faxes and phone calls. We’re building modern, robust software that solves this challenge. We currently operate across 49 states with most of the largest health systems in the US.

We’re a Series C company, backed by some of the best investors in technology and healthcare including General Catalyst, SignalFire, and Sapphire Ventures. We have ambitious expansion plans, so it’s a particularly exciting time to join the company as we’re aggressively expanding the team.

About the role

You will be our in‑house ex‑reviewer who ensures each surgical dressings order is fully compliant with every CMS regulation, including regulation / policies as they are applied by MACs & UPICs. You’ll translate LCDs/Articles and MAC playbooks into checklists, fix packet defects pre‑bill, and run our ADRs/appeals processes.

Please note that this role is an hourly, part-time engagement requiring ~10 hours per week. While this role is remote, Verse is headquartered in NYC and will require operating on East Coast time for deadlines.

What You’ll Do

• Policy → Practice

  • Interpret and operationalize LCD L33831 + Policy Article for surgical dressings; publish practical rules (when covered, limits, documentation phrases).

  • Stand up “go/no‑go” criteria for collagen, alginate/fiber‑gelling, foam, film, hydrocolloid; codify A‑modifier (wound count) usage, KX/GA/GZ/EY, sizing, quantity/frequency math.

• Pre‑Bill Controls

  • Build a 2‑gate QA (1: clinical completeness; 2: billing correctness) and pilot it on all surgical‑dressing claims.

  • Create/upgrade templates for various outreach.

• Audit & Appeals

  • Lead UPIC/MAC ADR responses (pre‑ and post‑pay).

  • Coach internal billing team; establish a reusable appeals library with policy citations and exemplars.

• Enablement & Analytics

  • Train customer-facing team members (30‑min modules) and billers on the specific documentation that satisfies the LCD.

  • Define and track metrics: initial denial %, appeal win %, ADR turnaround, % packets with signed POD, top‑defect Pareto.

What we’re looking for:

• 3–5+ years medical‑review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, Palmetto).

• Hands‑on adjudication of surgical dressings (A6021 collagen; A6196–A6199 alginate/fiber‑gelling; A6209–A6215 foam; A6212–A6214 bordered foam; A6216–A6221 gauze; A6257–A6259 film).

• Expert with proof‑of‑delivery standards, SWO requirements, frequency/sizing rules, and common denial rationales (e.g., two‑cover stacking, over‑frequency without rationale, DOS/POD mismatch). Most of our interview process is focused on your practical experience with the coverage guidelines.

• Crisp, policy‑anchored writing; calm under deadline; disciplined with PHI.

• Nice‑to‑haves: RN/WOCN or wound‑care background; supplier‑side pre‑bill experience; Excel/BI/SQL for denial analysis.